Pharmacist Impact on Treatment Intensification and Hemoglobin A 1C in Patients With Type 2 Diabetes Mellitus at an Academic Health Center

Abstract

Background:

Achievement of treatment goals for patients with type 2 diabetes mellitus (T2DM) is suboptimal. This is in part driven by a lack of treatment intensification when warranted, termed “clinical inertia.”

Objectives:

To investigate time to treatment intensification and changes in A1C among pharmacist–physician managed (PPM) patients compared to usual medical care (UMC) in patients with T2DM.

Methods:

Retrospective matched cohort study at 2 academic family medicine clinics. Patients in each cohort were matched 1:1 based on age (±5 years), primary care provider, gender, and race.

Results:

A total of 50 patients met inclusion criteria. Mean time to treatment intensification was longer in the UMC cohort as compared with the PPM cohort (325 (66) days vs 200 (62) days [P = .50]). A higher percentage of patients in the PPM cohort achieved ≥0.5% reduction in A1C in comparison to the UMC cohort (60% vs 44%, respectively [P = .41]). Patients in the PPM cohort experienced a greater mean decrease in A1C from baseline when compared to patients in the UMC cohort (−1% (1.8%) vs −0.4% (2.2%) [P = .24]).

Conclusion:

Patients exposed to a pharmacist in this retrospective matched cohort study experienced shorter time to treatment intensification and a greater reduction in A1C than those managed solely by a medical provider, although results were not statistically significant. Additional research is needed to evaluate the role of the pharmacist in improving clinical inertia in the management of T2DM.

Keywords

clinical inertia treatment intensification diabetes endocrinology ambulatory care

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References

Centers for Disease Control and Prevention. Chronic disease prevention and health promotion. At a glance fact sheets: diabetes. 2016. https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/diabetes-aag.pdf. Accessed May 3, 2018.

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–853.

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) Lancet. 1998;352(9131):854–865.

White

Sun

Cleary

, et al.; The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus. Arch Ophthalmol. 2008;126(12):1707–1715.

Casagrande

Fradkin

Saydah

, et al. The prevalence of meeting A1C, blood pressure and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36(8):2271–2279.

American Diabetes Association. Standards of medical care in diabetes: 2018. Diabetes Care. 2018;41(suppl 1):S1–S159.

American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) 2017 clinical practice guidelines for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2017;23(2):207–238.

O'Conner

Sperl-Hillen

Johnson

, et al. Clinical inertia and outpatient medical errors. In: Henriksen

Battles

Marks

Lewin

, eds. Advances in Patient Safety: From Research to Implementation. Rockville, MD: Agency for Healthcare Research and Quality; 2005 293–308.

Sheehan

. Treatment intensification for patients with type 2 diabetes and poor glycaemic control. Diabetes Obes Metab. 2016;18(9):892–898.

10.

Khunti

Wolden

Thorsted

, et al. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36(11):3411–3417.

11.

Khunti

Vora

Davies

. Results from the UK cohort of SOLVE: providing insights into the timing of insulin initiation in people with poorly controlled type 2 diabetes in routine clinical practice. Prim Care Diabetes. 2014;8(1):57–63.

12.

Khunti

Nikolajsen

Thorsted

, et al. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab. 2016;18(4):401–409.

13.

Pantalone

Wells

Chagin

, et al. Intensification of diabetes therapy and time until A1C goal attainment among patients with newly diagnosed type 2 diabetes who fail metformin monotherapy within a large integrated health system. Diabetes Care. 2016;39(9):1527–1634.

14.

Wetzler

Snyder

. Linking pharmacy and laboratory data to assess the appropriateness of care in patients with diabetes. Diabetes Care. 2000;23(11):1637–1641.

15.

Grant

Cagliero

Dubey

, et al. Clinical inertia in the management of type 2 diabetes metabolic risk factors. Diabetic Med. 2004;21(2):150–155.

16.

Grant

Buse

Meigs

. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28(2):337–442.

17.

Berlowitz

Ash

Glickman

, et al. Developing a quality measure for clinical inertia in diabetes care. Health Serv Res. 2005;40(1):1836–1853.

18.

Zhang

Rajagopalan

Marrett

, et al. Time to treatment initiation with oral antihyperglycaemic therapy in US patients with newly diagnosed type 2 diabetes. Diabetes Obes Metab. 2012;14(2):149–154.

19.

Shah

Hux

Laupacis

, et al. Clinical inertia in response to inadequate glycemic control. Diabetes Care. 2005;28(3):600–806.

20.

McEwen

Bilik

Johnson

, et al. Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes. Translating Research into Action for Diabetes (TRIAD). Diabetes Care. 2009;32(6):971–976.

21.

Yam

Adams

Divine

, et al. Clinical inertia in type 2 diabetes: a retrospective analysis of pharmacist-managed diabetes care vs. usual medical care. Pharm Pract. 2013;11(4):203–210.

22.

Centers for Disease Control and Prevention. Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Pharmacists. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. 2013. https://www.cdc.gov/dhdsp/pubs/docs/translational_tools_pharmacists.pdf. Accessed May 3, 2018.

23.

Moreau

Sando

Zambrano

. Assessing the effect of pharmacist care on diabetes-related outcomes in a rural outpatient clinic: a retrospective case-control study. Ann Pharmacother. 2017;51(6):473–478.

24.

American Diabetes Association. Standards of medical care in diabetes: 2014. Diabetes Care. 2014;37(suppl 1):S14–S80.

25.

American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement. Endocr Pract. 2013;19(2):1–48.

26.

Ackermann

Wallia

O’Brien

, et al. Correlates of second-line type 2 diabetes medication selection in the USA. BMJ Open Diabetes Res Care. 2017;5(1):e000421.

27.

Wishah

Al-Khawaldeh

Albsoul

. Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: randomized controlled trial. Diabetes Metab Syndr. 2015;9(4):271–276.

28.

Norris

Engelgau

Narayan

. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24(3):561–87.

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